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After Tooth Extraction

Our goal is providing you with the highest degree of surgical care as well as speedy and full recovery. Here are some instructions that could help you in your recovery. Remember if any unusual problems arise or you need immediate care go to the nearest emergency room and call our office. Please read the following instructions carefully. They will help you to understand the normal process and reactions following your surgery and help to keep you as comfortable as possible. Surgery of the mouth requires careful attention to post operative instructions.

MEDICATIONS

Patients taking medications to relieve pain or other drugs that may impair reflexes should not operate machinery, cars, etc, while taking these drugs. Antibiotics should be taken as directed until this prescription runs out. Antibiotics may impair the efficiency of oral contraceptives for the duration of the present cycle.

ANTIBIOTIC

If you were given a prescription for antibiotics like Penicillin (One tablet every 6 hours), Clindamycin (One capsule every 8 hours), or Keflex (One tablet every 6 hours), take it as scheduled. It may be advisable to take it after each meal and one before bedtime. Continue taking the antibiotics until they are finished usually in 5-7 days after surgery.

Allergic Reaction:

If an allergic reaction occurs, like rash, hives, or itching stop taking the medication and call our office or your Physician. If difficulty breathing occurs in United States call 911 because you need immediate emergency medical care. You could consider taking 25 mg of benadryl (an anti-histamine) to aliviate the problem, but remember you cannot drive after you take that as it can cause some degree of drowsiness. Always consult your doctors before taking any medications or if you also take other medications consult a pharmacist.

PAIN MEDICATION

Having pain after your surgery is expected and common. Pain may last up to two weeks after surgery. It is highly recommended to take two Advil or Motrin immediately when you get home. Keep the narcotic pain medications for bedtime.

For severe pain a narcotic pain medication such as Tylenol # 3 or Vicoprofen, Synalgos DC or a number of other strong pain relievers may be prescribed for you. Take them as indicated on the prescription. The initial dose may take up to an hour before is effective. (For this reason the first dose of your pain medication should be taken before the local anesthetic wears off.) Take 1 or 2 pills every 4-6 hours as needed for severe pain only. For mild discomfort, you may need to take Tylenol, Advil, Motrin, etc. When taking the pills, be sure to drink liquids prior to help prevent an upset stomach. If you develop itching, rashes or hives, stop all mediations and call our office. The prescription may not control all of you pain the first few days after surgery.

When taking narcotic containing pain medications (e.g. Tylenol #3, Vicoprofen, Vicodin, Etc.) DO NOT DRIVE A CAR OR OPERATE ANY MACHINERY. These medications can make you drowsy and impair your performance.

ANTI-SWELLING MEDICATION

When an anti-swelling medication such as Medrol or Decadron (Dexamethasone) is prescribed your face may feel warm and appear red. This is a side effect of this medication and is not an allergy. To correct these problems discontinue the medication. It will take a few days for the symptoms to disappear. Occasionally these medications can cause hiccups as well.

PRESCRIPTION MOUTH WASH

Do not rinse or spit during the first 24 hours after your surgery. You should begin rinsing with warm salt water (One half a teaspoon of salt to a glass of warm water) 24 hours after the operation. Do not rinse more than 4 times a day. Avoid excessive vigorous rinsing. This should be done 3 to 4 times a day – for at least 2 weeks after surgery. If you were given a special mouthwash such as Chlorohexidine (Peridex) start using it 24 hours after your surgery. Rinse your mouth with that only twice (2X) daily since this mouthwash will stain your teeth.

OTHER MEDICATION

Continue other medications (such as your blood pressure medications, insulin, etc), which you may have been taking routinely before your treatment in our office (unless otherwise directed.) If antibiotics have been prescribed, please continue and complete the entire dosage. Warning: Antibiotic may inhibit the effectiveness of oral contraceptives.

Always consult your pharmacist for drug interactions, as the consequences of drug interaction could be extremely dangerous to your health.

INTRAVENOUS INJECTION SITE

If you have had intravenous sedation involving a needle in your arm then the following can occasionally happen; bruising, redness, pain, numbness or swelling at the needle site in your arm. Please contact our office if this happens. This results from irritation of the vein by the medications. It is usually treated by warm compresses over the area. This is done with a warm moist face cloth. It will take a few days to disappear. -Infection of the intravenous site. This can be very serious if it happens. Usually this is extremely tender and warm to touch. You may also notice a red line going up your arm.

ACTIVITY AFTER ANESTHESIA

Due to the medications that you have received you must be accompanied home by a friend or relative and should not attempt to drive an automobile, ride a bike, or operate any type of machinery for at least 24 hours after the surgery. Initially you will feel drowsy and will only feel like sitting in a chair or lying in bed. Your activity level can slowly be increased to normal levels as you become more alert. The aim should be for moderate exercise the day after surgery, as tolerated.

1. Extractions & Impacted Teeth

Bleeding or oozing of blood from the surgical site is expected and the saliva may be tinged for 24 to 48 hours. Firm gauze should be maintained on the extraction sockets for three hours after the extraction. If bleeding is persistent, it should be controlled by placing a piece of sterile gauze or a tea bag dipped in ice cold water over the wound and biting on it for 1 hour. Repeat if necessary.

Do not rinse your mouth or spit out. It is important that the gauze packing is placed directly over the site where the tooth was removed and not over the adjacent teeth. The gauze must be bulky enough to prevent the upper and lower teeth from meeting when biting firmly.

2. SWELLING:

Apply ice to face in the area of the surgery for a period of 20 minutes on and 20 minutes off, for the first 3-6 hours after the surgery, while awake. Swelling is not uncommon after surgery. This may last for up to two weeks after surgery. Discoloration of the skin of the face and neck may occur within 10 days following surgery and should be no cause for alarm. Sleeping with your head elevated could help reducing the bleeding and swelling.

3. MOUTH RINSE:

Do not rinse your mouth or spit out for 24 hours after surgery. After this time use one half teaspoon of salt plus two tablespoons hydrogen peroxide in a glass of warm water and rinse gently after each meal. Patients who have had impacted teeth removed, should rinse after eating for approximately six weeks. Do not rinse more than 4 times a day. Avoid excessive vigorous rinsing. This should be done 3 to 4 times a day for at least 2 weeks after surgery. Do not rinse or brush the day of surgery.

4. DIET:

Cold, soft and bland foods are advisable for the first 24 hours. Good nutrition post-surgery is essential. Do not use a straw for drinking. Smoking can delay healing. Avoid peanuts, popcorn and other hard foods for 2 weeks or until the sockets have healed. Drink plenty of liquids. If you are diabetic, maintain your caloric intake, and take your medication as usual.

5. HYGIENE:

Continued proper oral hygiene is imperative. Normal care should be maintained, but the surgical area should be excluded from care involved when brushing, flossing, dental irrigation appliances, etc. until advised. Healing will occur more rapidly when good oral hygiene is maintained.

6. Exercise:

It will be beneficial to exercise your jaw by chewing sugarless gum starting 24 hours after the extraction and lasting for approximately one week.

7. FEVER:

An increased temperature of 100-101o F is not unusual for a few days following surgery. If after the third postoperative day your swelling increases or your temperature is greater than 101oF please contact our office.

8. SUTURES

We use self-dissolving sutures and they do not need to be removed. They may stay in your mouth up to 5 weeks.

9. PERSISTENT NUMBNESS

Your lips, tongue, chin; gum and teeth are going to feel numb for several hours after surgery. In some cases numbness or tingling in the lower lip or tongue may last longer. Depending to several factors such as proximity to nerves or pressure of the roots on the nerve under the teeth roots you may experience a very prolonged numbness. Although rare but in some cases this could last several years or be permanent. If you develop this condition you must be careful not to bite your lip or touch hot food to your lips since this can cause serious harm.

10. SMOKING:

Do not smoke for at least one week after you procedures. This may interfere with blood clot formation and increase the risk of postoperative pain.

11. NAUSEA

This is usually due to either swallowing of blood or sensitivity to the medications you are taking. A small amount of carbonated 7-Up or ginger ale every hour for 5-6 hours will usually terminate nausea. Follow this with weak tea or clear broth, avoiding juices, or diary products.

12. DRY & CHAPPED LIPS

The corner of the mouth may become chaffed and temporary cracking may appear as a result of retraction during surgery. Apply a thin coat of Vaseline to your lips every 3 to 4 hours while you are awake during the first few days after your surgery.

13. MUSCLE SORENESS:

It is not unusual to have some jaw muscle soreness and some limitation of opening following surgery. This soreness is temporary, and should disappear as the swelling subsides and the diet is resumed.

14. SHARP EDGES

If you feel sharp edges in the surgical areas with your tongue it is probably the bony wall, which originally supported the teeth. Occasionally small slivers of bone may work themselves out during the first few weeks after surgery. They are not pieces of tooth and, if necessary, we will remove them. Please call our office if you are concerned. Although rare but if you noticed a small remnant of teeth structures or feel any sharp object in the fracture site please return to our center for further evaluation.

15. DRY SOCKET

Dry socket is a very rare condition caused by an early loss of blood clot from the extraction site. It is characterized by dull throbbing pain, which may radiate to the ear. Remember having an increased pain on day 5-7 is not uncommon. To avoid dislodging the blood clot from the extraction site avoid rinsing your mouth, spitting, smoking or using straws with the first 24 hours after extraction. Smoking should be avoided for at least 10 days to reduce risk of postoperative complications.

16. BRUSING & JAW STIFNESS

Bruising (black and blue or yellow) and jaw stiffness, Pain in the jaw joint area (TMJ area) is common following surgical procedures. These will slowly subside. Stiffness, causing difficulty in opening the mouth and a slight earache and sore throat even one week after surgery is possible.

17. SINUS INVOLVEMENT

Due to the close relationship to the sinus, a communication will sometimes remain between the mouth and the sinus. This may have occurred in your case, therefore it is important to follow these instructions.

Do not blow your nose. Do not sneeze through your nose. If the urge to sneeze arises, sneeze with your mouth open. Avoid swimming and strenuous exercise for at least one week. It is not uncommon to have a slight amount of bleeding from the nose for several days.

18. FOLLOW UP VISIT

Depending to your particular type of surgery we may need to see you in a week to assess your healing progress. Call us if you had any question or come back for further evaluation. We care for you.

Keep fingers and tongue away from socket or surgical area.

Here is more information

After tooth extraction, it’s important for a blood clot to form to stop the bleeding and begin the healing process. That’s why we ask you to bite on a gauze pad for 30-45 minutes after the appointment. If the bleeding or oozing still persists, place another gauze pad and bite firmly for another 30 minutes. You may have to do this several times.

After the blood clot forms, it is important not to disturb or dislodge the clot as it aids healing. Do not rinse vigorously, suck on straws, smoke, drink alcohol or brush teeth next to the extraction site for 72 hours. These activities will dislodge or dissolve the clot and retard the healing process. Limit vigorous exercise for the next 24 hours as this will increase blood pressure and may cause more bleeding from the extraction site.

After the tooth is extracted you may feel some pain and experience some swelling. An ice pack or an unopened bag of frozen peas or corn applied to the area will keep swelling to a minimum. Take pain medications as prescribed. The swelling usually subsides after 48 hours.

Use the pain medication as directed. Call the office if the medication doesn’t seem to be working. If antibiotics are prescribed, continue to take them for the indicated length of time, even if signs and symptoms of infection are gone. Drink lots of fluid and eat nutritious soft food on the day of the extraction. You can eat normally as soon as you are comfortable.

It is important to resume your normal dental routine after 24 hours. This should include brushing and flossing your teeth at least once a day. This will speed healing and help keep your mouth fresh and clean.

After a few days you will feel fine and can resume your normal activities. If you have heavy bleeding, severe pain, continued swelling for 2-3 days, or a reaction to the medication, call our office immediately at 610-667-6161.